Provider Demographics
NPI:1467136895
Name:PATH TO RECOVERY LLC
Entity Type:Organization
Organization Name:PATH TO RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:SHARIFF
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-999-8057
Mailing Address - Street 1:1240 3RD AVE E STE 107
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1749
Mailing Address - Country:US
Mailing Address - Phone:952-324-5146
Mailing Address - Fax:952-456-8456
Practice Address - Street 1:1240 3RD AVE E STE 107
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1749
Practice Address - Country:US
Practice Address - Phone:952-324-5146
Practice Address - Fax:952-456-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty